There is longstanding inequity in access to transplantation, substantial nonuse of donated organs, and unexplained variability in performance across the transplant system, according to a report from The National Academies of Sciences, Engineering, and Medicine.1
About one in five donated kidneys are unused, many of which could be transplanted successfully. The report authors recommended lowering this rate to 5% or less, offering some suggestions to make it easier for transplant centers to say “yes” to organ offers.
One example is expedited placement policies for offered kidneys at high risk of nonuse to direct those organs to transplant centers with a history of using difficult-to-place kidneys. Changes in surgical scheduling also are needed to allow organ transplants seven days a week.
Motivated by this concerning report, a group of ethicists authored a paper focusing on accountability and transparency in the U.S. organ donation and transplantation system.2 In August 2022, the Senate Finance Committee held a hearing to update committee members on the investigation into United Network of Organ Sharing (UNOS) and express their concerns with UNOS’s oversight of the U.S. Organ Procurement and Transplantation Network (OPTN).3
“This further underscored the importance of effectively and efficiently addressing these issues,” says Samantha Klitenic, JD, one of the paper’s authors and an assistant research scientist at NYU Langone Transplant Institute. By writing this article, says Klitenic, “it was our intention to hold the OPTN contractor accountable and ensure transparency in OPTN operations.”
One goal is to raise public awareness as the federal government decides how they want to oversee the operations of the U.S. transplant system. Macey Levan, JD, PhD, director of the Center for Surgical and Transplant Applied Research Qualitative Core at NYU Langone Health, says, “While the government decides what the next OPTN contract and contractor should look like, we hope that the current OPTN contractor [UNOS] will consider diverse voices and external science as it supports their search for new executive leadership.”
REFERENCES
1. National Academies of Sciences, Engineering, and Medicine. Realizing the Promise of Equity in the Organ Transplantation System. 2022.
2. Levan ML, Klitenic S, Massie A, et al. Questions of accountability and transparency in the US organ donation and transplantation system. Nat Med 2022;28:1517-1518.
3. U.S. Senate Finance Committee. A system in need of repair: Addressing organizational failures of the U.S.’s Organ Procurement and Transplantation Network. Aug. 3, 2022.
There is longstanding inequity in access to transplantation, substantial nonuse of donated organs, and unexplained variability in performance across the transplant system, according to a recent report.
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